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The Quality Improvement Guide Improving Quality Together Improving Quality Together The Quality Improvement Guide The Quality The Improving Quality Together Edition Improvement Guide The Quality Improvement Guide brings together learning The Improving Quality Together Edition from around Wales – and further afield - to explain how a simple set of techniques can be applied to improve the services provided by NHS Wales. It will encourage all staff to apply these techniques and be part of introducing change to bring about improvements. This guide supports the Improving Quality Together national learning programme, which provides a common language for improvement in NHS Wales. “Improving Quality Together has given us a shared vocabulary and understanding as a team. It gives the whole team a different dimension and a different perspective and it has really paid off for us.” – Julia Toy, Business Manager, Powys Teaching Health Board people of Wales. If you would like to find out more about IQT, visit www.IQT.wales.nhs.uk Includes examples of IQT projects Published by 1000 Lives Improvement which is part of Public Health Wales NHS Trust 1 The 1000from Lives Plus across Quality Improvement Wales! Guide The Quality Improvement Guide Contents 1. Introduction 5 2. Improving quality requires putting the 9 person at the centre of care 3. Delivering improvement through teamwork 15 and leadership 4. Using the Model for Improvement 19 5. Testing changes 37 6. Communicating your improvement 43 7. Common improvement questions 47 The Quality Improvement Guide: 8. Improving Quality Together in action 51 The Improving Quality Together Edition Copyright © 2014, 1000 Lives Improvement 9. References 59 All rights reserved. First edition: March 2014. This guide is adapted from The 1000 Lives Plus Quality Improvement Guide published in 2011, 2013. 10. Introducing Improving Quality Together 63 These materials may be photocopied for educational, not-for-profit uses, as long as the contents are not altered in any way and that 1000 Lives Improvement is named as the source of the content. These materials must not be reproduced for commercial use, or republished under any Published by 1000 Lives Improvement, 14 Cathedral Road, Cardiff CF11 9LJ circumstances, without written permission from 1000 Lives Improvement. Phone: (029) 2082 7653 How to cite this publication: 1000 Lives Improvement (2014), Email: [email protected] The Quality Improvement Guide: The Improving Quality Together Edition Web: www.1000livesi.wales.nhs.uk Cardiff: 1000 Lives Improvement 2 The Quality Improvement Guide The Quality Improvement Guide 3 1 Introduction 4 The Quality Improvement Guide The Quality Improvement Guide 5 Introduction Introduction Introduction NHS Wales has been on a journey of quality improvement for several years. We have seen great success in making patient care safer, reducing delays and wastage, and making sure services across Board Wales offer the same level of high quality care everywhere. Bronze However, we know there is still room for improvement. The Silver experience of people using our health services is that care is often Gold excellent, but excellence is not reliably and consistently guaranteed. This guide introduces a common language for improvement and some The quality improvement work in Wales in the last ten years has of the techniques underpinning Improving Quality Together, and which shown that those working in NHS Wales are committed to improving are explored further in the Improving Quality Together Bronze level care - we know that nobody wants to cause harm or offer poor e-learning modules. There are also case studies that show how these quality care for their patients. techniques can be applied in different settings, to encourage and equip everyone working in NHS Wales to be a catalyst for improving However, the biggest challenge has been using the right techniques care for the people of Wales. to achieve improvement. In NHS Wales we all have two roles: Doing our job and improving our The Improving Quality Together learning programme gives staff a job. Therefore, the first question we need to ask is: “How are we set of common techniques to achieve improvements in care. This going to improve things?” common and consistent approach to improving the quality of services can be used by any member of staff anywhere across NHS Wales. We need to realise that improvement usually comes through small It will also help improvements take place more quickly and changes that make a measureable difference. Quality is rarely the spread effectively throughout the country. result of learning brand new knowledge, exciting innovations or one-off changes. Instead, we need to focus on the regular and often Improving Quality Together consists of three main levels of painstaking work of providing a reliable service and continuously development with a complementary Board level. Bronze level raises trying to improve what we do (Berwick 1992 I and Berwick 1992 II). awareness of the common language for quality improvement in NHS Wales, Silver level takes that learning into application, Gold level Experience in Wales and across the world has shown that some focuses on developing coaching capability for quality improvement simple principles and techniques can increase success. Even so, across NHS Wales, and the Board level focuses on leading system- improvement will only be maintained and spread if those techniques wide quality improvement and assurance. are widely understood and shape the way that whole organisations work (Shortell, 1998). 6 The Quality Improvement Guide The Quality Improvement Guide 7 Introduction For improvement to be maintained there must be: • Will - We must want to improve; • Ideas - We must know what to try; • Execution - We must know how to change. (Berwick, 2003 and Nolan, 2007) The Bronze level of Improving Quality Together is the ideal introduction to these themes. The Bronze level takes about two hours to complete four e-learning modules. There are also more in-depth guides called ‘How to Improve’ and ‘Leading the Way to Safety and Quality Improvement’ which are available from 1000 Lives Improvement. Instructions on how to complete the Bronze level of Improving Quality Together can be found at www.IQT.wales.nhs.uk. 2 Improving quality requires putting the person at the centre of care 8 The Quality Improvement Guide The Quality Improvement Guide 9 Improving quality requires putting the person at the centre of care Improving quality requires putting the person at the centre of care Improving quality requires putting the • Person-centered - care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring person at the centre of care that patient values guide all clinical decisions. The people we care for should be at the heart of all that we do. Our • Safety - avoiding harm to staff and patients from the care that starting point should always be what is best for the person is intended to help them. as a whole. • Effective - care based on scientific knowledge to all who could benefit and refraining from actions to those not likely to Analysing the real life experiences of people in your care helps to benefit. determine what individuals want and expect from their care. Patients are not outsiders to the healthcare system. In many ways, they are • Timely - reducing waits and harmful delays for both those who the only true ‘insiders’. They are the ones who experience healthcare receive and those who give care. most personally – the reliability of the system and effectiveness • Efficient - avoiding waste, of equipment, supplies, ideas, of treatment can literally be a matter of life or death to a patient and energy. (Davies, 2012). • Equitable - care that does not vary in quality because of The Institute of Medicine includes person-centred care as one of the personal ccharacteristics such as gender, ethnicity, geographic location, and socio-economic status. six domains which constitute quality in healthcare (National Research Council, 2001): Evidence shows that person-centred care can lead to improved quality, reduced waste, a better experience of care, and better Six domains of quality in healthcare use of resources. 10 The Quality Improvement Guide The Quality Improvement Guide 11 Improving quality requires putting the person at the centre of care Improving quality requires putting the person at the centre of care There are a number of definitions of person-centred healthcare How to achieve person-centred care available from across the globe and they all have common themes: Shared decision making • Users identifying areas that need to change. The majority of individuals want to play an active role in their • Involvement in decision making and respect for patients’ treatment decision. Shared decision making tools are designed to preferences. support patients during consultations when presented with different • Empathy, dignity, compassion and emotional support. treatment options. Option grids are developed to support such treatment choices and encourage an equal partnership with those we • Clear, comprehensible and timely communication. care for. • Fast and smooth access to optimal care. • Education and empowerment to manage their conditions Provide dignified care and care for themselves. Dignity in care is at the heart of caring for people. It allows everyone to effectively engage in their care as partners and is a cornerstone A genuine partnership between the public and healthcare to person-centred care. Simple things such as supporting individuals professionals must exist to design and deliver true person-centred to set their own daily goals and helping them achieve simple tasks care. To achieve this, staff need to view the services being delivered can have a big impact in their healthcare experience. This has been through ‘the patients’ eyes’, in order to meet their needs in the ways achieved in Wales through the use of simple questions, such as ‘What most valuable to them. can I do for you today?’ Three simple questions that are helpful in achieving person-centred care are: Communicate effectively 1.
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